National Institute on Drug Abuse Drug Abuse and HIV/AIDS Nora D. Volkow, M.D. Director National Institute on Drug Abuse

Estimated Number of AIDS Cases and Deaths Among Adults and Adolescents By Exposure Category United States and Dependent Areas The proportional distribution of AIDS cases by transmission category has shifted since the beginning of the epidemic. In 1985, male-to-male sexual contact accounted for 64% of all AIDS cases; in 2006, this transmission category accounted for 43% of all AIDS cases. The proportion of AIDS cases attributed to injection drug use increased during 1985–1994 and then slightly decreased, accounting for 19% of cases in 2006. The proportion of AIDS cases attributed to male-to-male sexual contact and injection drug use decreased from 9% in 1985 to 5% in 2006. The proportion of AIDS cases attributed to high-risk heterosexual contact increased from 3% in 1985 to 32% in 2006. The remaining AIDS cases were those attributed to hemophilia or the receipt of blood or blood products and those in persons without an identified risk factor. The data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed.

Although It Has Improved in Some Places, Injection Drug Use Remains A Significant HIV Transmission Mode In Many Regions of the World Estimated Number of Adults & Children Living With HIV Oceania Latin America and Caribbean Asia Middle East & North Africa North America and W & C Europe Sub-Saharan Africa Eastern Europe & Central Asia 40 MSM Hetero, IDU 35 IDU, Hetero 30 MSM, Hetero, IDU Number of people living with HIV (millions) 25 MSM, Hetero, IDU 20 IDU 15 Hetero, IDU↑ 10 5 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Year

Source: Des Jarlais et al AIDS, 21: 231-235, 2007. Convergence of HIV Seroprevalence Among Injecting and Non-injecting Drug Users Drug Treatment Program Respondent-Driven Sampling (n=448 2004) (n=2121 2001-2004) 5 10 15 20 5 10 15 20 17% 15% CI 12-21% 13% CI 11-19% 12% CI 12-15% CI 9-16% HIV Prevalence Current Injectors Non-Injectors Current Injectors Non-Injectors Source: Des Jarlais et al AIDS, 21: 231-235, 2007.

Drug and Alcohol Intoxication MARKEDLY Disrupt Brain Function: Effects of alcohol intoxication on brain metabolism sober intoxicated (0.1 mg%)

In Adults, Emotional Self Regulation Is Normally Implemented By A Neural Circuit Comprising Various Prefrontal Regions…& Subcortical Limbic Structures Source: Beauregard, M. et al., Journal of Neuroscience 21 RC165, 2001. Sexual Arousal Condition Attempted Inhibition Condition Attempted Inhibition Condition

Effects of Alcohol Intoxication on Brain Glucose Metabolism (Marker of Brain Function) Decreases prefrontal cortex cingulate gyrus Increases amygdala Alcohol decreases activity of areas involved with control and increases activity of areas involved with emotional reactivity

In the United States, Minorities are Disproportionately Affected by HIV/AIDS Infection

Reported AIDS Cases, By Racial/Ethnic Group Cumulative Through 2006 United States and Dependent Areas The proportional distribution of AIDS cases among racial/ethnic groups has changed since the beginning of the epidemic. The proportion of AIDS cases in whites (not Hispanic) has decreased while the proportions in blacks (not Hispanic) and Hispanics have increased. The proportion of AIDS cases among Asians/Pacific Islanders and American Indians/Alaska Natives has remained relatively constant, at approximately 1% of all cases. Of persons diagnosed with AIDS in the United States and dependent areas in 2006, 48% were black, 29% were white, 21% were Hispanic, 1% were Asian/Pacific Islander, and less than 1% were American Indian/Alaska Native. The data have been adjusted for reporting delays. Slides containing more information on HIV and AIDS in racial and ethnic minorities are available at http://www.cdc.gov/hiv/topics/surveillance/resources/slides/race-ethnicity/index.htm.

Estimated Number of Adults and Adolescents Living with AIDS By Sex United States and Dependent Areas This slide shows increases in the number of adults and adolescents living with AIDS in the United States and dependent areas from 1993 through 2006. The increase is due primarily to the widespread use of highly active antiretroviral therapy, introduced in 1996, which has delayed the progression of AIDS to death. At the end of 2006, an estimated 447,720 adults and adolescents were living with AIDS; of these, 77% were males and 23% were females. The data have been adjusted for reporting delays.

Reported AIDS Cases, By Sex and Transmission Category, Cumulative Through 2006 United States and Dependent Areas Of AIDS cases diagnosed in 2006 among male adults and adolescents, 59% were attributed to male-to-male sexual contact and 16% were attributed to injection drug use. Approximately 17% of cases were attributed to high-risk heterosexual contact and 7% were attributed to male-to-male sexual contact and injection drug use. Most (73%) of the AIDS cases diagnosed in 2006 among female adults and adolescents were attributed to high-risk heterosexual contact, and 24% were attributed to injection drug use. The data have been adjusted for reporting delays and cases without risk factor information were proportionally redistributed.

HIV Seroconversion at 18 Months By Receipt of Treatment Among IDUs the Most Effective HIV/AIDS Prevention Strategy is Drug Abuse Treatment HIV Seroconversion at 18 Months By Receipt of Treatment 25 20 No treatment Partial treatment Rate of Seroconversion (%) 15 Continuous treatment 10 5 Treatment Status Source: Metzger, D. S., Woody, G. E., McLellan, A. T., O’Brien, C. P., Druley, P., Navaline, H., De Philipps, D., Stolley, P., & Abrutyn, E. (1993). Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: An 18-month prospective follow-up. Journal of Acquired Immune Deficiency Syndromes, 6, 1049-1056.

Although We Do Have Treatments That Work We Face Some Major Challenges in Using Them Criminal Justice System’s Reluctance to Use Many Countries’

Future Research Long-Acting Injectable Medications Depot Naltrexone 80% 192 mg Dose Placebo 384 mg Dose 70% Long-Acting Injectable Medications (i.e. Depot Naltrexone) Immunotherapies for Addiction Treatment (i.e. Vaccines) 60% 50% % Negative Urines 40% 30% 20% 10% 0% 2 4 6 8 10 12 14 16 18 Visits (2 per week) Comer, S.D., et al. Arch Gen Psych, 63, 210-218, 2006.

Since Vaccine Strategies Have Not Yet Worked We Need to Focus More Efforts on Prevention Strategies and their Implementation

Extended Back-Calculation Model, Estimated New Human Immunodeficiency Virus (HIV) Infections by Transmission Category, Extended Back-Calculation Model, 50 US States and the District of Columbia, 1977-2006 80000 70000 60000 50000 40000 30000 20000 10000 MSM IDU MSM/IDU Heterosexual Injections 1977- 1979 1980- 1981 1982- 1983 1984- 1985 1986- 1987 1988- 1990 1991- 1993 1994- 1996 1997- 1999 2000- 2002 2003- 2006 Period Hall, H. I. et al. JAMA 2008;300:520-529. Copyright restrictions may apply.